CPT CODE and description

87880 – Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A  – average fee amount – $20 – $30

87561 – Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique

Coding for Reflex Testing
Some clinicians may desire to use both rapid immunoassay and molecular Strep A testing methods in a reflex testing scheme. This scheme is analogous to reflexing a rapid immunoassay to culture in which the molecular test is used in place of culture. For example, the initial test might be performed with a rapid immunoassay and then reflexed to molecular if the immunoassay results are negative but clinical signs suggest Strep A infection.
While the codes described above apply separately to these different testing technologies, both are Strep A tests. There is a Correct Coding Initiative (CCI) edit for CPT® 87880 and 87651. This CCI edit CANNOT be overcome by a modifier. Therefore, for Medicare and any other payer that utilizes CCI edits, billing for both tests of this reflex testing scheme is not permitted.
Coding for CPT® 87880 and 87651 may be permitted by some non-Medicare payers if they do not utilize CCI edits. Providers should contact non-Medicare payers to determine whether billing for both CPT® 87880 and 87651 is permitted.
Note that ordering clinicians must be aware of any reflex testing policy by a laboratory and should only order reflex testing if medically reasonable and necessary
Coding Summary

Test             CLIA         Payer           CPT® Coding
Rapid Immunoassay
Acceava®, BinaxNOW®, or Clearview® brands or other Strep A tests manufactured by Alere
Waived Medicare 87880QW
Waived Non-Medicare 87880
Amerigroup Reminder: We Cover Rapid Strep Tests
Reminder: Rapid strep tests billed with CPT code 87880 are covered. This test should be completed for any child prescribed an antibiotic for pharyngitis
What this means to you: For your information only. No immediate action is  necessary
Background
As part of our annual Healthcare Effectiveness Data and Information Set (HEDIS) audit, we assess appropriate testing for children with pharyngitis. The Centers for Disease Control and Prevention and the National Committee for Quality Assurance guidelines constitute the basis for this HEDIS measure.
As part of our audit, we review members’ medical records, claims and laboratory data.
 During our last audit, many of you said Amerigroup Community Care does not reimburse for rapid strep tests; therefore, you don’t file claims for this service. 
We want you to know Amerigroup does cover the rapid strep test when you file a claim using CPT code 87880. Pharyngitis can be validated through lab results; therefore, it serves as an indicator of appropriate antibiotic use. Attached is a summary sheet for this measure and the appropriate codes to use for diagnosis and payment.
We know many parents and guardians request or insist on antibiotics when they aren’t necessary for treatment. We count on your excellent training and cooperation to comply with this standard for appropriate antibiotic use.

Billing example
Mrs. x’ Visit
• Physician Visit – CPT 99202
• Nursing Work – CPT – (Office)
• Rapid Strep – CPT 87880
• All Linked to ICD-9 Code 462 (Pharyngitis)
Payments
• Medicare Pays $36.8729 per RVU
– 1.73 RVUs X 36.8729 = $63.790117
– Rapid Step (CPT 87880) = $16.01
• Total Payment From Medicare = $79.80



Strep Antigen Test List

Abbott Signify Strep A Dipstick Innovacon 87880QW
Abbott Signify Strep A Test Wyntek 87880QW
Acceava Strep A Twist Rapid Test Innovacon 87880QW
Acceava Strep A Test Innovacon 87880QW
Accustrip Strep A Princeton Biomeditech Corp 87880QW
Acon Strep A Rapid Strip Test Acon 87880QW
Acon Strep A Twist Rapid Test Acon 87880QW
Alere, Strep A, Alere I Instrument Alere Scarborough, Inc 87880QW
Applied Biotech SureStep Strep A (II) Applied Biotech, Inc 87880QW
Applied Biotech SureStep Strep A Exact Applied Biotech, Inc 87880QW
BD Veritor System for Rapid Detection of Group A Strep Becton Dickinson & Co. 87880QW
Beckman Coulter ICON DS Strep A Test Princeton BioMeditech 87880QW
Beckman Coulter ICON FX Strep A Test (formerly SmithKline) Binax 87880QW
Beckman Coulter Primary Care Diagnostics ICON DS Strep A Test Acon Laboratories 87880QW
Beckman Coulter Primary Care Diagnostics ICON SC Strep A Test Acon Laboratories 87880QW
Beckman Coulter Primary Care Diagnostics ICON FX Strep A
Immunochemical Strep A Antigen Test Beckman Coulter, Inc. 87880QW
Becton Dickinson Chek Group A Strep Test Innovacon, Ind 87880QW
Becton Dickinson LINK 2 Strep A Rapid Test Becton Dickinson 87880QW
Binax Clearview Advanced Strep A Binax, Inc 87880QW
Binax NOW Strep A Test Binax, Inc 87880QW
BioStar Acceava Strep A Test BioStar 87880QW
Biotechnostix Rapid Response Strep A Rapid Test Devise/Strip Acon Laboratories 87880QW
BTNX Rapid Response Strep A Rapid Test Strips Sa Scientific, Inc 87880QW
Cardinal Health SP Brand Rapid Test Strep A Dipstick / Rapid Test
Strep A Cassette Applied Biotech, Inc. 87880QW
Cardinal Health Strep A Cassette and Dipstick-Rapid Test Alere Sd 87880QW
Clearview Strep A Exact Dipstick Applied Biotech, Inc. 87880QW
CLIA Waived Inc Rapid STREP A Test Sa Scientific Inc 87880QW
Consult Diagnostics STREP A Rapid Dipstick Innovacon, Inc 87880QW
CTMI Strep A Rapid Test Strip Innovacon, Ind 87880QW
DE Healthcare Products, TruView Strep A Test / Strep A Cassette DE Healthcare Products 87880QW
Diagnostic Test Group Clarity Strep A Rapid Test Strips Princeton BioMeditech Corp 87880QW
Fisher HealthCare Sure-Vue Strep A (direct from throat) Applied Biotech, Inc. 87880QW
Genzyme Contrast Strep A Genzyme Diagnostics 87880QW
Genzyme OSOM Ultra Strep A Test (25 test kit) Genzyme Diagnostics 87880QW
Germaine Laboratories StrepAim Rapid Dipstick Test (Strep Group
A) Acon Laboratories, Inc. 87880QW
Germaine Laboratories Strep AIM Tower Acon Laboratories, Inc. 87880QW
Henry Schein Inc, OneStep+ Strep A Test / OneStep+ Strep A
Dipstick Test / OneStep+ Strep A Cassette Test / OneStep Pro+ Henry Schein, Inc 87880QW
ICON DS Strep A Test ACON Laboratories, Inc. 87880QW
IMI Signify Strep A Dipstick Innovacon Inc 87880QW
Immunostics Detector Strep A Direct ACON Laboratories, Inc. 87880QW
Immunostics Immuno/StrepA Detector ACON Laboratories, Inc. 87880QW
Instant Tech iStrep One Step Strep A Test ACON Laboratories, Inc. 87880QW
Inverness Med BioStar Acceava Strep A Test ACON Laboratories, Inc. 87880QW
Inverness Med BioStar Acceava Strep A Twist Innovacon, Inc 87880QW
Inverness Medical Clearview Strep A Exact II Dipstick Innovacon, Inc. 87880QW
Inverness Medical Signify Strep A Cassette Innovacon, Inc 87880QW
Jant Pharmacal AccuStrip Strep A (II) Jant Pharmacal 87880QW
Jant Pharmacal AccuStrip Strep A Value+ Test Strip Innovacon 87880QW
Jant Pharmacal Accutest Integrated Strep A Rapid Test Device Jant Pharmacal 87880QW
Jant Pharmacal Clinipak Strep A Rapid Test Strip Jant Pharmacal 87880QW
Laboratory Supply Company (LSC) PEP Strep A Cassette / PEP
Strep A Dipstick Test Acon Laboratories Co 87880QW
LABSCO Advantage Strep A Princeton BioMediTech Corp 87880QW
Roche Molecular, cobas Liat System IQuum, Inc. 87880QW
LifeSign LLC Status Strep A Princeton BioMediTech Corp 87880QW
Mainline Confirms Strep A Dots Test Mainline Technology, Inc 87880QW
McKesson Consult Diagnostics Strep A Test Dipstick Alere 87880QW
McKesson Medi-Lab Performance Strep A Test Dipstick/Cassette Applied Biotech, Inc. 87880QW
McKesson Medi-Lab Strep A Test Dipstick Innovacon, Inc. 87880QW
McKesson Medi-Lab Strep A Test – Twist Innovacon, Inc. 87880QW
McKesson Strep A Test Dipstick/Cassette Applied Biotech, Inc. 87880QW
Medline Strep A Test Strips {Throat Swabs} Alere, INC. 87880QW
MediLab Performance Strep A Twist Rapid Test MediLab 87880QW
Meridian Diag. ImmunoCard STAT Strep A Meridian Diagnostics 87880QW
Moore Medical The Supply Experts Strep A Test – Cassette Innovacon, Inc 87880QW
Moore Medical The Supply Experts Strep A Rapid Test – Dipstick Innovacon 87880QW
Mooremedical Strep A Rapid Test – Dipstick Alere San Diego Inc 87880QW
PEP Performance Enhanced Products Strep A Cassette Test /
Strep A Dipstick Acon Laboratories 87880QW
PerMaxin Rediscreen Strep A Rapid Test Acon Laboratories 87880QW
PerMaxin Rediscreen Strep A Twist Cassette Innovacon 87880QW

Polymedco, Inc. Poly Stat A (II) for Group A Strep [direct from throat swab] Applied Biotech, Inc. 87880QW
Poly stat Strep A Flip Test Princeton BioMediTech Corp 87880QW
Poly stat Strep A Strip Test Princeton Biomeditech Corp 87880QW
Polymedco Poly Stat Strep A Dipstick Innovacon 87880QW
Polymedco Poly Stat Strep A Liquid Test Polymedco 87880QW
Princeton BioMediTech BioStrep A Test Princeton BioMediTech Corp 87880QW
Princeton Biomeditech Status First Strep A Princeton BioMediTech Corp 87880QW
ProAdvantage by NDC Strep A Test Innovacon 87880QW
PSS Consult Diagnostics Strep A Dipstick Innovacon 87880QW
PSS World Medical Select Diagnostics Strep A Dipstick Innovacon 87780QW
PSS World Medical Select Diagnostics Strep A Twist Innovacon 87780QW
Quidel QuickVue Dipstick Strep A Quidel 87880QW
Quidel QuickVue In-Line Strep A Quidel 87880QW
Quidel QuickVue In-Line One-Step Strep A Quidel 87880QW
Quidel Sofia Strep A+ FIA (from throat swab only) Quidel Corp 87880QW
RAC Medical Clarity Strep A Twist Rapid Strep Test Device/Strip Acon laboratories, Co 87880QW
SMC Direct, LLC, RefuAH Strep A Rapid Wondfo Biotech Co., LTD. 87880QW
Remel RIM A.R.C. Strep A Test (direct from throat swab) Applied Biotech, Inc. 87880QW
SA Scientific SAS Strep A (direct from throat swab) SA Scientific, Inc. 87880QW
Sacks Medical Refuah Strep A Rapid Test Acon Laboratories 87880QW
StatusFirst Strep A Princeton BioMeditech Corp 87880QW
Select Medical Products Brand Rapid Test Strep A Dipstick Innovacon, Inc 87880QW
Sekisui Diag OSOM Strep A Test (direct throat swab) Sekisui Diagnostics 87880QW
Sekisui Diag OSOM Ultra Strep A Test Sekisui Diagnostics 87880QW
Select Medical Products Brand Rapid Test Strep A Twist Innovacon, Inc 87880QW
Signify Strep A Dipstick Applied Biotech, Inc. 87880QW
SmithKline ICON Fx Strep A Test (from throat swab only) Binax 87880QW
Stanbio Laboratory E-Z Well Strep A Rapid Device Test Acon Laboratories Co 87880QW
Stanbio Qustick Strep A Acon Laboratories Co 87880QW
StrepAim Princeton Biomeditech Corp 87880QW
Wondofo One Step Strep A Swab Test Guangzhou Wondfo Biotech Co., LTD. 87880QW
Wyntek Diagnostics OSOM Strep A Test Wyntek Diagnostics, Co 87880QW
Wyntek Diagnostics OSOM Ultra Strep A Test Wyntek Diagnostics, Co 87880QW